The Fight Against Tuberculosis Continues

DW-WORLD.DE: The World Health Organization (WHO) estimates that in the next 10 years around 30 million people worldwide will die of tuberculosis. Does the disease receive as much public attention as it ought to?

Timo Ulrichs: No, the public perception and the significance of infectious diseases like TBC are usually even inversely proportional to each other. One saw that when it came to mad cow disease: There was a big media fuss but few infections. With tuberculosis it's the exact opposite: Every third person is infected with tuberculosis pathogens worldwide - around 2 billion people in total -- but there's no general consciousness. At the same time, tuberculosis is among the three big worldwide killers -- along with HIV and malaria.

Which regions are most affected by tuberculosis?

There are two large regions that create the most problems for us: on the one side, they are African countries, mainly south of the Sahara. There along with the high rate of tuberculosis, there's also a high rate of HIV. Those diseases facilitate each other. On the other side, East Asia, Russia and eastern Europe are heavily affected by TBC.

Tuberculosis was inadequately treated there for a long time, so that in the meantime many resistances have turned up in the tuberculosis pathogens. And these strains spread from Asia to eastern Europe. Recently, someone even found one of the so-called "extremely multi-resistant strains," which are resistant to almost all medications, from Asia on the way to South Africa and which infected 53 HIV patients. Fifty of them died.

Despite the fact that the disease is not a new phenomenon, there is still no vaccine to stop it. Why is that?

There's the vaccine BCG, for which an affect against tuberculosis in adults has not been proven. That's why it's not recommended in Germany anymore.

In developing new vaccines there is one main difficulty: understanding exactly how the pathogen settles in the body. Namely, it has a very deft system to make itself invisible in the body for years by shutting down its own metabolism. It even sits in the immune system itself. To develop a vaccine, on the other hand, would mean training the immune system so that it's able to recognize and kill such "intracellulars," that is, the pathogens found in the cells.

Since an infection with TBC doesn't protect the body from being attacked by a further tuberculosis pathogen, the vaccine would have to be better protection than the natural infection. That's not an easy task.

Tuberculosis is much more widespread in developing countries than in industrial countries. Are western medications too expensive for the people there?

No, the WHO even distributes the medications for free. But they expect a certain amount of preparation for it: It must be guaranteed that tuberculosis diagnosis works in the particular country. That means, that medications are not dispensed haphazardly but rather in the right combination over many months. The WHO developed its own program for that with the acronym DOTS. That stands for "directly-observed therapy short course." Countries that have completely assumed this program of diagnosis and supervised therapy receive the medications from the WHO.

The quality control of the diagnosis takes place in national and super-national diagnostic labs, so-called "reference centers." An additional committee then decides whether the country will also receive the medications that are used for the second level of therapy -- they are significantly more expensive. This procedure also shows very good successes. In Ghana, for example, the number of cases of disease as well as the number of resistant pathogens has fallen strongly through the DOTS program.

Why is tuberculosis so widespread in eastern Europe?

In the Baltic states it has to do with the fact that the HIV rate, with around 1 percent, is very high. These countries don't have large populations but a very high interchange (of people), with western Europe, too. Since the 1990s, the rate of HIV has increased rapidly, but the efforts to get it under control are great -- through excellent cooperation with institutions on a European level and the WHO. And since HIV and tuberculosis often go together, one can also deal with tuberculosis in the course of the fight against AIDS.

In Russia, the picture is relatively heterogeneous: in some regions tuberculosis is very much under control, on the border to the Central Asian states and Mongolia, however, it's still very widespread. In Russia, the TBC rate is calculated separately among the population and in prisons -- in total though the number is now falling for the first time.

The Koch Metschnikow Forum is meant to be founded soon as the world's first bilateral organization focused on interdisciplinary cooperation in the area of infectious diseases and you will head its tuberculosis department. Why choose Russia as a cooperation partner?

The impetus for the forum has to do directly with the fight against tuberculosis: In 2001 Berlin's Max Planck Institute for Infection Biology, where I then worked, contacted the central TBC research institute in Moscow. In Russia, patients with extensive pulmonary tuberculosis are operated on to reduce the pathogens. In the course of that, the doctors remove parts of organs that have been attacked by the disease -- and they were highly interested for our TBC research. In subsequent years, we expanded the cooperation, above all when it came to questions of microbiology and epidemiology, and finally we decided to concentrate the German-Russian cooperation between doctors and scientists in a "forum" to fight infectious diseases.

Fighting infectious diseases is not only on the forum's agenda but also on that of the G8 conference on infectious diseases that started Monday. What can industrial nations which are relatively lightly affected by tuberculosis do to make a difference in the fight against TBC?

They can make a difference if they decide definitely to help. Above all, if they provide money for research, but also their expert knowledge, their technical know-how -- and the ability to develop and guide international networks.

Timo Ulrichs is a specialist in tuberculosis at the Institute for Microbiology and Hygiene at Berlin's Charite hospital. He is a member of the Russian Academy for Natural Science.